USS COLLETT Reunion Association 
        Registration Form for 2012 Providence
        This form must be in 30 days prior to Reunion.
        Contact Sue immediately for any possible lateness.

        Name:     _____________________________________________________

        Address:  _____________________________________________________

        City:     ______________________  State: ___  Zip: ____________


        Name for Badge:  ______________________________________________

        Years on board the USS COLLETT:  ____ to ____

             Companion:  ______________________________________________

                Guests:  ______________________________________________

                         ______________________________________________
         
                         ______________________________________________

                         ______________________________________________

        List any special dietary needs:

        _______________________________________________________________

        _______________________________________________________________

        _______________________________________________________________

        ALL FEES ARE PER PERSON.
        Registration  $7.50   Number attending __  Subtotal ___________

        Thursday Tour $42.00  Number attending __  Subtotal ___________
          Newport Tour.
        Friday Tour   $28.00  Number attending __  Subtotal ___________
          Newport Navy Base Tour
        Saturday Tour $54.00  Number attending __  Subtotal ___________
          Battleship Cove Tour
        Banquet       $40.00  Number attending __  Subtotal ___________

        Dues are $10.00 per year.

        Dues 2011 ______ 2012 ______ 2013 ______   Subtotal ___________

                                                      Total ___________

        Make checks payable to;  USS COLLETT Reunion Association

        Mail Registration form and checks to 
        Sue Senn
        P.O.Box 742
        Pearce, AZ  85625